| NPI | 1609909803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD27021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 112974) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-10-02 |